Healthcare Provider Details

I. General information

NPI: 1295860831
Provider Name (Legal Business Name): WOODSTOCK MEDICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 RTE 171
S WOODSTOCK CT
06267-0366
US

IV. Provider business mailing address

PO BOX 366 168 RTE 171
S WOODSTOCK CT
06267-0366
US

V. Phone/Fax

Practice location:
  • Phone: 860-928-9270
  • Fax: 860-928-3852
Mailing address:
  • Phone: 860-928-9270
  • Fax: 860-928-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD W KLARE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 860-928-9270